Hommura F, Nishimura M, Oguri M, Makita H, Hosokawa K, Saito H, Miyamoto K, Kawakami Y
First Department of Medicine, Hokkaido University School of Medicine, Kita-ku, Sapporo, Japan.
Am J Respir Crit Care Med. 1997 Apr;155(4):1482-5. doi: 10.1164/ajrccm.155.4.9105099.
A 57-yr-old man with idiopathic central apnea is reported. He presented at our hospital complaining of excessive daytime sleepiness. Polysomnography, including esophageal pressure monitoring, confirmed central sleep apnea with an apnea index of 27/h. He had mild non-insulin-dependent diabetes mellitus (NIDDM) but no signs of diabetic neuropathy or other background diseases. The ventilatory responses to hypoxia and hypercapnia tested while he was awake indicated increased respiratory chemosensitivity. We applied nasal continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BPAP) in an attempt to compare the possible difference in therapeutic efficacy. Although nasal CPAP completely reversed central apnea, nasal BPAP adversely affected both apnea length and frequency in an applied pressure-dependent manner. Arterial blood gas analyses while he was being treated indicted alveolar hypoventilation with CPAP and hyperventilation with BPAP. Additionally, administration of a mixed gas containing 5% CO2 through a face mask had a significant effect on the disappearance of central apnea in this patient. These findings support the theory that the arterial PCO2 level is critical in generating idiopathic central apnea and that nasal CPAP therapy may be effective in eliminating central apnea by raising the PaCO2.
报告了一名57岁的特发性中枢性呼吸暂停男性患者。他因白天过度嗜睡前来我院就诊。包括食管压力监测在内的多导睡眠图证实存在中枢性睡眠呼吸暂停，呼吸暂停指数为27次/小时。他患有轻度非胰岛素依赖型糖尿病（NIDDM），但无糖尿病神经病变或其他基础疾病的迹象。他清醒时对低氧和高碳酸血症的通气反应表明呼吸化学敏感性增加。我们应用鼻持续气道正压通气（CPAP）和双水平气道正压通气（BPAP），试图比较治疗效果的可能差异。尽管鼻CPAP完全逆转了中枢性呼吸暂停，但鼻BPAP以压力依赖的方式对呼吸暂停时长和频率产生了不利影响。治疗期间的动脉血气分析显示，使用CPAP时存在肺泡通气不足，使用BPAP时存在通气过度。此外，通过面罩给予含5%二氧化碳的混合气体对该患者中枢性呼吸暂停的消失有显著影响。这些发现支持以下理论：动脉血二氧化碳分压水平在特发性中枢性呼吸暂停的发生中至关重要，鼻CPAP治疗可能通过提高动脉血二氧化碳分压来有效消除中枢性呼吸暂停。
